Provider Demographics
NPI:1396175758
Name:AJCA, MARTHA C (PAC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:AJCA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17051 SIERRA LAKES PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336
Mailing Address - Country:US
Mailing Address - Phone:909-428-2040
Mailing Address - Fax:909-428-2191
Practice Address - Street 1:17051 SIERRA LAKES PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336
Practice Address - Country:US
Practice Address - Phone:909-428-2040
Practice Address - Fax:909-428-2191
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2015-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA51264363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant